To evaluate the effect of type 2 diabetes on the clinical course and prognosis of women with ST-segment elevation myocardial infarction (STEMI) and diabetes.
A total of 26,035 consecutive patients ...with STEMI who were hospitalized in 456 hospitals in Poland during 1 year were analyzed. The data were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS).
Type 2 diabetes occurred more frequently in women than in men (28 vs. 16.6%; P < 0.0001). The proportion of women was larger among patients with diabetes (47.1 vs. 31.3%; P < 0.0001), and compared with women without diabetes, diabetic women had worse clinical profiles. Women with diabetes were most frequently treated conservatively. Both women and men with diabetes had significantly more advanced atherosclerotic lesions than women without diabetes. Women with diabetes had the highest in-hospital, 6-month, and 1-year mortality rates. Multivariate analysis indicated that type 2 diabetes was a significant independent risk factor for in-hospital and 1-year mortality in women with STEMI. Primary percutaneous coronary intervention (pPCI) was a significant factor associated with the decreased 1-year mortality in women without diabetes.
Type 2 diabetes was a significant independent risk factor for in-hospital and 1-year mortality in women with STEMI. Women with diabetes had the poorest early and 1-year prognoses after STEMI when compared with women without diabetes and men with diabetes. Although pPCI improves the long-term prognosis of women with diabetes, it is used less frequently than in women without diabetes or men with diabetes.
The aim of this work was to analyze temporal trends in clinical presentation, treatment methods, and outcomes of patients in Poland with non–ST-segment elevation myocardial infarction (NSTEMI) from ...2004 to 2010. A total of 90,153 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2004 to 2010 were analyzed. The main outcome measure was all-cause mortality after 12 months, identified from official mortality records. The percentage of admissions for NSTEMI among all acute coronary syndromes increased from 24% in 2004 to 38% in 2010 (p <0.0001). From 2004 to 2010, the percentage of invasive treatment for NSTEMI increased significantly, almost threefold, to 83% (p <0.0001). The frequency of recurrent myocardial infarction and stroke during hospitalization decreased significantly over the years, while the frequency of major bleeding increased. Twelve-month mortality decreased significantly throughout the time period, from 19.1% to 14.5%, but was stable in patients treated invasively and slightly higher in the last years in patients treated noninvasively. The invasive treatment of NSTEMI (relative risk 0.62, 95% confidence interval 0.57 to 0.67, p <0.0001), together with the pharmacotherapy recommended by the guidelines, had a significant impact on reducing 12-month mortality in a multifactor analysis. In conclusion, the distinct improvement in the short- and long-term prognoses of patients with NSTEMI may be in part the result of the popularization of invasive treatment and the optimization of pharmacotherapy.
Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ...ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting.
Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications.
Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women.
There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy.
Previous studies have shown disappointing results for immunosuppressive treatment in patients with dilated cardiomyopathy. Therefore, we studied the effectiveness of such therapy in patients with HLA ...upregulation on biopsy.
Of 202 patients with dilated cardiomyopathy, 84 patients with increased HLA expression were randomized to receive either immunosuppression or placebo for 3 months; they were then followed for 2 years. After 2 years, there were no significant differences in the primary end point (a composite of death, heart transplantation, and hospital readmission) between the 2 study groups (22.8% for the immunosuppression group and 20.5% for the placebo). The secondary efficacy end point included changes in ejection fraction, end-diastolic diameter, end-diastolic volume, end-systolic volume and NYHA class; left ventricular ejection fraction increased significantly in the immunosuppression group compared with the placebo group (95% CI, 4.20 to 13.12; P<0.001) after 3 months of follow-up. The early favorable effects of immunosuppressive therapy on left ventricular volume, left ventricular diastolic dimension, and New York Heart Association class were also present. This improvement was maintained in the immunosuppression group at 2 years (ejection fraction: 95% CI, 6.94 to 19.04; P<0.001). In addition, on the basis of the protocol-specified definition of improvement, 71.8% patients in the immunosuppression group versus 20.9% patients in the placebo group met the criteria of improvement after 3 months (P<0.001). At the end of the follow-up period, 71.4% patients from the immunosuppression group versus 30.8% patients from the placebo group were improved (P=0.001).
These data demonstrate a long-term benefit of immunosuppressive therapy in patients with dilated cardiomyopathy and HLA upregulation on biopsy specimens. Thus, restoration of immunosuppressive therapy for such patients should be considered.
The study was aimed to compare the characteristics and inhospital and 12- and 36-month outcomes of men and women <40 years with acute coronary syndrome (ACS). The analysis involved 932 patients ...<40 years with ACS in the Silesia region enrolled into the ongoing, prospective Polish Registry of Acute Coronary Syndromes from January 2006 to December 2014. The composite end point involved death, recurrence of ACS, a need for percutaneous coronary intervention, and coronary artery bypass graft surgery within 12 and 36 months after ACS. Compared with men, women <40 years were less frequently smokers (66.1% vs 55.4%, p = 0008), had older average age (35.6 ± 4.2 vs 34.7 ± 4.4, p = 0.002), more often had unstable angina at admission (29.1% vs 19.3%, p <0.001), and less frequently had ST-elevation myocardial infarction: 41.3% versus 51.3%, p = 0.02, at admission. There was no significant difference in the mortality (4.8% vs 3.1%, p = 0.29) and the composite end point (21.6% vs 16.0%, p = 0.14) within 12 months after ACS. Compared with men, women had a higher incidence of the composite end point (28.4% vs 20.1%, p = 0.04) and indicated a tendency of a higher mortality within the 36-month follow-up period (9.2% vs 5.0%, p = 0.055). Female gender turned out to be an independent risk factor of death in the multivariate analysis (hazard ratio 2.76, 95% confidence interval 1.21 to 6.31, p <0.016). In conclusion, women had a higher incidence of the composite end point and showed a tendency toward a higher mortality than the men within the 36-month follow-up period.
INTRODUCTION Patients under the age of 40 years represent from 1% to 6% of all patients with acute myocardial infarction (AMI). OBJECTIVES We aimed to analyze the recent trends in the clinical ...presentation, treatment, and both the in‑hospital and 12‑month outcomes of patients under 40 years of age with ST‑segment elevation myocardial infarction (STEMI) and non‑STEMI (NSTEMI), treated from 2009 to 2013. PATIENTS AND METHODS The study included 1639 young patients with AMI under the age of 40 years included in the PL‑ACS registry (1.3% of all patients with AMI). Trends in the period from 2009 to 2010 (643 patients) and from 2012 to 2013 (676 patients) were analyzed. RESULTS The percentage of admissions for STEMI decreased (71.7% vs 63.9%; P = 0.002), while that of admissions for NSTEMI increased (28.3% vs 36.1%; P = 0.002) over the years. There was no difference in the in‑hospital mortality (1.7% vs 1.6%; P = 1.0). The percentage of patients treated invasively increased from 90.7% in the period 2009-2010 to 95.7% in the period 2012-2013 (P = 0.0003). There was no difference between the groups in the incidence of death (2.5% vs 2.8%; P = 0.72) or the rate of the composite endpoint of death, recurrent AMI, or stroke within 1 year of the index hospitalization (5.3% vs 5.6%, P = 0.80). CONCLUSIONS There was no significant difference in the in‑hospital and 12‑month outcomes between the patients under 40 years of age with STEMI and NSTEMI hospitalized in the years 2009-2010 and those treated in the years 2012-2013. The relative percentage of patients with NSTEMI and those treated invasively increased significantly over the years.
Long‑term follow‑up data from a large Polish acute myocardial infarction (AMI‑PL) database are still unavailable.
This study aimed to assess the 5‑year outcomes of patients discharged after ...hospitalization for AMI in Poland in relation to age.
The studywas based on the nationwide AMI‑PL registry including data on the management and long‑term outcomes of all patients admitted to hospitals with AMI (codes I21-I22 according to the International Classification of Diseases and Related Health Problems, 10th Revision ICD ‑10), derived from the database of the obligatory healthcare payer in Poland.The current analysis included all patients after AMI who were discharged alive between the years 2009 and 2010 (n = 134 602).
The median age of the study patients was 66.8 years, 62.8% of them were male, and 57.1% had ST‑segment elevation myocardial infarction. Older patients, especially those at age ≥80 years, were less likely to receive invasive treatment during the index hospitalization and follow‑up. There were 37 437 deaths during the follow‑up, and the observed 5‑year survival ranged from 0.921 in women at the age below 55 years to 0.383 in men older than 80 years. Relative survival, however, ranged from 0.94 to 0.68 in these age‑sex groups. The mortality risk increased with age, was higher in men, in patients treated noninvasively, hospitalized for non-ST‑segment elevation myocardial infarction, and discharged from non‑cardiology wards. Patients were rehospitalized due to cardiovascular reasons in 63% of cases, heart failure in 17.9%, and AMI in 12.8%.
More than 1 in 4 patients discharged after hospitalization for AMI died within 5 years. Age strongly affects the treatment and long‑term outcomes of AMI patients. Our findings indicate the need for improvement in secondary prevention after AMI.
We aimed to compare the characteristics and in-hospital and 12-month outcomes in patients aged >40 and <40 years with acute coronary syndrome. The analysis involved 789 patients aged <40 years and ...63,057 patients aged ≥40 years enrolled in the ongoing Polish Registry of Acute Coronary Syndromes from October 2003 to December 2009. Patients aged <40 years with acute coronary syndrome differed from older patients in their clinical characteristics, treatment, and clinical outcome. The older patients more frequently had pulmonary edema (2.9% vs 0.4%, p <0.0001) and cardiogenic shock (4.7% vs 2.8%, p = 0.011) on admission. For the younger patients, coronary angiography and percutaneous coronary intervention were performed more often (71.5% vs 60.5%, p <0.0001 and 51.5% vs 47.7%, p = 0.04, respectively). The younger patients had a lower mortality rate than the older patients during hospitalization (1.5% vs 5.2%, p <0.0001) and during 12-month follow-up period (4.1% vs 13.4%, p <0.0001). Multivariate analysis revealed that age <40 years was one of the strongest factors associated with lower mortality during the 12 months after discharge (hazard ratio 0.42, 95% confidence interval 0.29 to 0.62, p <0.0001). In conclusion, younger patients had more favorable in-hospital and 1-year outcomes than older patients, and the age <40 years was revealed to be one of the strongest factors associated with lower mortality during the 1-year follow-up.
Given that up to 2% of patients with myocardial infarction (MI) are young women, the purpose of this study was to evaluate factors affecting outcomes in young women with ST-segment-elevation ...myocardial infarction (STEMI) aged less than or equal to 45 years. We evaluated 796 women with STEMI aged less than or equal to 45 years between 2007 and 2014, and mortality was 4.0%. Death occurred more often in women with prehospital sudden cardiac arrest, and severe symptoms of heart failure; less commonly, the women were subjected to percutaneous coronary intervention (PCI), with a higher rate of incomplete revascularization. Beta blockers (BB) and angiotensin converting enzyme inhibitors were frequently used in the survivor group. The independent predictor of 30-day mortality was as follows: inability to undergo PCI (odds ratio OR 4.6, 95% confidence interval CI 1.45-14.76, P = 0.009), sudden cardiac arrest (OR 4.5, 95% CI 1.5-18.3, P = 0.04). An increase in systolic blood pressure for every 5 mm Hg was associated with lower mortality, OR 0.90, 95% CI 0.76-0.97 in patients without cardiogenic shock (CS) and OR 0.69, 95% CI 0.61-0.78, P < 0.0001 in the group with CS. Predictors for 1-year mortality were the inability to undergo PCI (hazard ratio HR 84, 95% CI 1.6-43.1, P = 0.01) and CS (HR 6.97, 95% CI 1.39-34.7, P = 0.01). An increase of 5% in left ventricular ejection fraction reduced the mortality rate for 60% (HR 0.40, 95% CI 0.26-0.63, P < 0.0001) and an increase in systolic blood pressure for every 5 mm Hg reduced mortality for 34% (HR 0.66, 95% CI 0.52-0.84, P = 0.02). Both short- and long-term outcomes in young women aged less than or equal to 45 years with STEMI are good. The strongest predictor for both 30-day and 1-year mortality was the inability to undergo PCI. Suboptimal use of beta blockers and angiotensin converting enzyme inhibitors affect the outcomes in young women. Hypotension in the acute phase of MI increased mortality in young women, independent of coexisting CS.
INTRODUCTION Individual comorbidities have been shown to adversely affect prognosis in heart failure (HF). However, our knowledge of multimorbidity in HF and understanding of its prognostic ...implications still remain incomplete. OBJECTIVES We aimed to analyze the prevalence of multimorbidity in Polish HF patients and to investigate the quantitative and qualitative impact of comorbidity burden on 12‑month outcomes in that population. PATIENTS AND METHODS We retrospectively analyzed data of 1765 Polish patients with ambulatory or acute (requiring hospitalization) HF from 2 multicenter observational European Society of Cardiology registries: the ESC‑HF Pilot Survey (2009-2010) and ESC‑HF‑LT Registry (2011-2013). RESULTS Arterial hypertension and coronary artery disease were the most prevalent comorbidities, similarly to the entire European cohort. The great majority of HF patients had more than 1 predefined comorbidity and the most frequent number of comorbidities was 3. Importantly, in almost half of the patients, 4 or more comorbidities were reported. The best accuracy for predicting the adjusted 12‑month rate of all‑cause death was ensured by the model including only anemia and kidney dysfunction. The model including 4 comor-bidities-anemia, kidney dysfunction, diabetes, and coronary artery disease-provided best accuracy for predicting 12‑month rate of composite all‑cause death or HF hospitalization. CONCLUSIONS Multimorbidity is highly prevalent in a real‑world cohort of Polish HF patients and the quantitative burden of comorbidities is related to increased mortality. In such patients, the clinical profile characterized by pathophysiological continuum of diabetes, kidney dysfunction, and anemia is particularly associated with unfavorable outcomes.
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